THE

SHOULDER

Dr. Muh. Sak+ SpOT

 Shoulder Anatomy
A ball and socket joint :
3 bones : Scapula
Clavicle
Humerus

+ Bursa and Labrum

 Shoulder Anatomy
5 Articulations :
Glenohumeral (GH)
Scapulothoracic (ST)
Sternoclavicular (SC)
Acromioclavicular (AC)
Coracoclavicular (CC)
 Shoulder Anatomy
Muscles :
Superficial :
Trapezius, Pectoralis Major & Minor,
Latissimus dorsi, Teres Major, Deltoid,
Serratus Anterior, Rhomboid, Levator
Scapulae, Biceps Triceps.
 Shoulder Anatomy
Muscles :
Deep Rotator Cuff (RC) (4) :
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Extension
= backward
elevation Flexion
Small range 45 Shoulder
elevation in
60
sagital plane
Normal ROM
+ 180
decrease with
age
 Three phases
1. 0 - 60 Shoulder joint
2. 60 - 120
Scapulo-thoracic joint
3. 120 - 180
SJ ST & Flexion of
trunk to the opposite site
Axial Rotation of the arm
In any position of the shoulder
Voluntary rotation at joint with 3 axis & 3 degree of
freedom
Reference point : arm hanging vertically
Performed with elbow flexed 90

1. Lateral rotation
2. Medial rotation
 Scapulo-humeral muscles
In 2 sleeves
Outer sleeve: deltoid & teres major
Inner sleeve : subscapularis
supraspinatus rotator cu
infraspinatus
teres minor
The 2 sleeves glide on each other
Subacromial bursa gliding mechanism
 Stability of GH joint ctd
Superior GH ligament restricts inferior
transla+on
Collec+vely the capsular ligaments and labrum
are staBc stabilizers
Dynamic stability by rotator cu and long head
of biceps
A thrower relies on dynamic eect of rotator
cu for joint compression to avoid capsule
stretching
 SHOULDER INSTABILITY
lose its stability-> humeral head move out of
the socket of the joint
The humeral head (ball) can move either
par+ally (sublux) or completely (dislocate) out
of the socket.
The humeral head can dislocate or sublux
forward (anterior), backward (posterior), or
out the boVom of the joint (inferior).
 CAUSES
Trauma
->most common cause
->humeral head forcefully subluxed or dislocated
->capsule, ligaments, or labrum can be stretched, torn,
or detached from the bone
->heal in a loose or stretched posi+on;recurrent
Congenital
->loose shoulder ligaments
->instability can occur without any trauma or following
rela+vely minor injury.
 EXAMINATION
If anteriorly dislocated
loss of the normal deltoid contour,
palpa+on of the shoulder demonstrates prominance
of the acromion process laterally and posteriorly,
a prominent humeral head can be felt anteriorly,
the arm is maintained in a par+al externally rotated
and abducted posi+on
 In posterior disloca+on
-> pa+ent most oYen holds the arm in internal
rota+on and adduc+on
-> ROM is limited, especially in external
ota+on and forward exion
-> coracoid is more prominent on the
dislocated side
-> anterior shoulder seems at when
compared to the opposite side.
 INVESTIGATIONS
Most cases are diagnosBc from history + PE
Xray:AP / true AP
CT scan -> bone lesions
MRI -> rotator cu injury
 TREATMENT
ANTERIOR GLENOHUMERAL DILOCATION :
NON OPERATIVE :
Closed reduc=on : trac=on-countertrac=on,
hippocra=c technique, s=mpson technique, Milch
technique,kocher maneuver.
OPERATIVE :
Indica=on : soG =ssue interposi=on, displaced
greater tuberosity fracture, glenoid rim fracture,
 POSTERIOR GLENUHUMERAL DISLOCATION

NON OPERATIVE :
closed reduc=onsupine posi=on, trac=on
be applied adducted arm in the line of
deformity with gentle liGing of the humeral
head into the glenoid fossa
OPERATIVE :
indica=on : major displacement + lesser
tuberosity fracture, a large posterior glenoid
fracture, irreducible disloca=on, open
disloca=on